Dr. Lakshmanan S, IAS, Mission Director, National Health Mission (NHM), Assam recently released a set of five books on Public Financial Management developed by the research and policy team at ACCESS Health International. The books include a diagnostic report, two training modules and two facilitators’ guides. These knowledge products were developed based on the findings of a study titled “Strengthening of Public Financial Management Systems in Assam” conducted by ACCESS Health International. The study was nested within the US-AID funded and IPE Global commissioned project titled “Vriddhi”. 

The books were released on July 27, 2021 towards the end of a six day long virtual training workshop on Public Financial Management System (PFMS) under the National Health Mission (NHM) conducted by ACCESS Health International. This training was designed for district and block level finance personnel working under the National Health Mission, Assam.  A total of 293 participants comprising of 34 District Accounts Managers, 21 Assistant Accounts Managers, 8 Finance and Logistic Consultants (Non-Communicable Diseases), 194 Block Accounts Managers, 18 Primary Health Centre Accountants and 18 other State / District / Block level finance personnel participated in the workshop. 

The study team lead by Maulik Chokshi, Director Health Systems included Tushar Mokashi, Arun Nair, Rajeev Prasad, Sawan Sharma, and Roshan Singhee and was supported by officials from the Government of Assam, USAID and IPE Global.

Public financing of healthcare has increased in the recent times mainly due to investments through centrally sponsored schemes of the National Health Mission and publicly sponsored health protection programs. With a growing demand for healthcare financing and constrained fiscal capacity of states for investing in health, there is an additional focus on using the available money efficiently. In the current scenario, it is imperative to undertake a similar assessment of the Public Finance Management (PFM) System across the country to enhance the efficiency of public spending, ultimately leading to improved health outcomes towards achieving UHC. 

The PFM assessment identifies key bottlenecks and misalignments as well as root causes in how revenues are allocated and implemented in health, and identification of mismatches, right from the state capital to frontline providers. PFM studies also allow the assessment of the government resource flow process starting from planning, allocations, and disbursement to implementation. PFM assessment can therefore help in identifying the glitches related to efficiency, effectiveness, and equity in public expenditures, in particular governance and incentive problems, and capture the bottlenecks, delays, leakages, and inequity. Further this can help in estimating the potential financial gains from addressing PFM bottlenecks and in shifting of priority if required. 

Strengthening PFM systems at the state level can reduce deviations from the planned and actual heath expenditure and bring about transparency in the budget process, improve the quality of spending, ensure accountability, and improve health outcomes. The assessment also allows for the identification of areas that need strengthening within the human resources cadre of public financial management. Leveraging the experience of conducting diagnostic analysis of PFM systems in Assam and developing the capacity building modules for training, similar assessments can be done in other states across India.